Why not remove whole thyroid for treatment of lump in throat??

[Still_Hoping]

Hello, I'm new. Long story short I have had hypo symptoms mostly for 7 years. Docs kept saying normal (above a 2.0) TSH. Finally, in a six mo period I went from a 2.47 to a 5.4. Saw an Endo who refused to treat or ultrasound. He blew me off basically, as all of them have.  By that time I was having some throat pressure (light) and dry cough. That was almost a year ago. 2 months after I saw the Endo, I began to have sudden chest pain and panic attacks. Acute ones. Went to my GP who said you have classic "Chostochondritis" from stress. He gave me Xanax, which helped the panic attacks..the chest pain got alot less frequent but still exist at times, though not bad. Along with indigestion at times. Anyway, GP wanted me to get the panic under control before treating the thyroid at all.  7 months pass (which brings me to now) and my panic is under control. But the throat pressure remains. Period chest pain remains. And, I decided to have bloodwork done. My TSH went to 12.27.  One year ago it was a 2.45 or thereabouts.  My ARNP (G.P fill in)said over the phone she is putting me on Synthroid 50mcg which I begin tomorrow AM (I'm told to take it before breakfast).  
I don't really want to live with a pressure in my throat the rest of my life, and this dry cough and all that... and I'm wanting to know when taking Levo does the pressure ever go away? Also, if not...then why don't they just remove the entire thyroid gland to fix this throat pressure thing for people?
I will be having a CT or an U/S hopefully soon. I see my ARNP next week and will ask for one.  I'm only 38!

[gassy]

Thanks for the info I'll keep you posted on my next diagnosis.

[Still_Hoping]

I forgot to answer you Gassy on costochondritis.  Okay basically, the cartilage and the ribs...this is what it is... it's an inflammation in this area...to be very general.  "itis" generally means inflammation when you see it at the end of a word such as thyroiditis, etc.  costo/chond....are shortened terms relating to the ribs and the cartilage...

That's a basic explanation... so what my doc was saying is that I had some inflammation in there... and it caused some migrating chest pains. Inflmmatory process can be caused from a number of reasons.... our bodies 'defense' system if you will...and yes even stress. Typical reasons for this condition are having just recovered from a bout of pneumonia...or..a bad cough..etc.... but also stress.  I looked all this up after he said I had it...and it's widely found on the net if you do a search on it...

It is benign/harmless. Treatment consists if they treat it at all, with some anti-inflammatory meds. I happened to feel some relief with the NSAID drug we know as Ibuprofin... so wasn't treated with steriods or coricosteriods...which are also for inflammation typically.... and have various side effects (gee if we could only invent drugs w/out side effects ha ha)
Hope that helps.

[Still_Hoping]

Hi :)  I'm not sure if vocal chord etc polyps are heriditary per say - if there is a familial history of polyps of the colon, however, they 'say' that you are more likely to have them, however, anymore it seems they are quite common (in the colon)... colonoscopys are becoming more widely used as a screening tool anymore these days (that is for the colon).

As to the throat, sometimes knowing 'all' the possibilities of what can go wrong with the human body can be overwhelming (!)...so I'm not going to go into all the stuff that it could be in the throat, as it's just borrowing trouble...but some of the more minor stuff would be what DrMark said (allergy/sinus, acid reflux) and then polyps etc... so don't worry, take it easy....and just keep looking into it...good idea to follow up w/those ENT and allergist/asthma docs..and then go from there. Your ENT may be able to rule out stuff, so might your allergist.   I also want to point out that panic attacks, when acute can make you feel as though your throat is closing..and the more you concentrate the worse they get so.... perhaps you may want to discuss with your physician some short term anxiety treatment (not anti depressants)... it may be worth discussing in the interim until you can find out what is causing this. It sounds as if you are having alot of difficulty with the throat and I know it CAN be scary..anxiety doesn't help that situation if you have anxiety about it...so it may merit discussion with your docs on that factor as well.  


Again this is only my personal opinion..I'm not a doc.... just a nursing student... and I dont give medical advice! ;)

[gassy]

Thanks for your information. I am going to ask to see an ENT and yes I do have allergies and will be following this up too. However when you mentioned polyp my aunt had polyp's so this is very interesting, not that I know anything about them but maybe it's heritary? I will be researching this next. I do have one last question what is Costochondritis? I did research it however just couldn't get a understanding of it.Is it associated with the heart? Thanks again I sure do appreciate everyone's knowledge and concern.

[Still_Hoping]

Dr Mark - thanks again and yes you have answered all my questions completely. There *are* viable treatment options for those with thyroid caused throat pressure and that is good news at least. Regarding panic attacks, I do tend to agree in my case (particularly because I am hypo and don't seem to match signs of Hashi's necessarily)  that those panic attacks of mine were independent of thyroid and probably my GP was correct in his dx of Costochondritis in my case. ( I have a pretty good GP now, I think insofar as GP's go). I refused tx with anti-depressants and rarely take any Xanax any more and they pretty much self resolved with diet, exercise and faith. As I said my GP also did not feel that thyroid (hypo) state would have anything to do with causing a panic attack and in fact, felt my hightened TSH at the time may have lessened their impact. He never discussed Hashi's with me - He said once my thyroid was going into a high TSH range it would not ever come down on it's own and I would remain high (so perhaps he was not thinking of Hashi's with their "swings" they may have?).

Jim_  - Though it took me time to finally get to this GP I do like him. He didn't mention Hashi's to me but perhaps that is because I was in the midst of an acute panic attack at the time (ha ha). He was dealing with that situation and was only answering briefly my question to him could my hypo have caused this attack - the answer was no. And could my TSH ever go to norm on it's own - the answer was no. He didn't enter into a conversation about thyroid disease other than to say lets treat the panic first and deal with the thyroid on follow up. Good enough for me. I nearly collapsed in his office b/c my O.H. was so bad from that attack. I hadn't eaten or slept in 4 days (though I'd taken lots of sports drinks in). Anyway, he had to deal with me for that cause.  I guess I gave you the wrong idea and I apologize if I misled you but I have a good GP and ARNP. Absolutely my history in trying to get treated was hard to deal with! I sure got blown off alot!   But this doc has never blown me off.
If they (panic attacks) occur again I'll naturally have my TSH tested to see if perhaps my med (just begun today) needs adjustment but, I still feel it's me rather than my thyroid causing these in my case. Just want to clarify that for Jim_ and others.

Gassy - OK here is my take on it since you asked me. As I said before, Dr Mark has noted a couple of the main causes of what throat pressure may be, and sinuses are one of them. Now I'm not at all speaking for Dr when I say this please understand this is my limited knowledge speaking here and my personal opinion only:  If I were you, I would see, next, perhaps an ENT doc. They can do other studies on your throat pressure - and the test I'm sorry to say may be invasive and not fun but, it's a diagnostic tool.  Also, you may consider an allergist/asthma doctor as well.  You may inflammation in there from a variety of causes - perhaps you have an allergy that you are unaware of and you are having inflammation from that. You may even perhaps have a polyp on your vocal chords ...or a number of other issues.  So, if you have had your scan done and your thryoid is clear and that I agree you should have other things looked at. have you tried getting an Air purifier with a hepa filter? And a Hepa vaccuum? To clear the air..etc. Do you live in a city with lots of smog? I mean I could go on. But the possibilities are large so, I'd go see the other docs and see what they have to say since your thryoid has been "cleared" as being the cause of your inflammation.  With me, for example if my pressure is not from my thyroid (to be determined) then I will suspect allergies/sinusitis and I will speak to my GP about it. But I have alot of allergies and colds and stuff. My throat is dry, and I have a dry cough; these again can be caused from many sources and unfortunately it is up to us to seek the docs who may be able to get down to it for us.  If you don't have a known history of allergies you may go to the ENT first. But that is what I'd consider if I were you.  I don't find that mine is partiuc. worse at night per say; but allergies and sinuses DO tend to get worse at night just a thought there.... for whatever reason they are known for that.

Well here is wishing us all the best of luck in getting rid of our throat pressures, from whatever cause they may be! (And I'm willing to be they are all different causes)

Sorry to be so long winded!

[gassy]

Yes, I hear what you are saying however since this episode I'm experiencing I have no sinus problem no indigestion problem and at times it does feel like a swollen gland however more muscular because of the tightening. Now my meds have been lowered so you would think that if this was thyroid related I would be having some relief by now. If at the beginning my thyroid was enlarged my July 27 u/s showed a small thyroid with no nodules. With my symptons and christine01 having the same, AM is better than PM because the tightening gets worse there has to be a explanation to what is happening in the throat that would cause this to come and go during a day and everyday at that I have had not one minute of relief. Is this viral or muscular anyone's guess however I am going to pursue till I do get an answer that I feel fits the symptons. Please if either one gets a diagnosis please inform me and I will do the same. Thanks.

[Mark Lupo, M.D.]

Gassy - Still_Hoping's response answers the question on my behalf.

If the goiter is large and not decreasing with synthroid, the the options are radioactive iodine or surgery - the iodine is less invasive but only works in certain circumstances although our experience with it is improving.  In either case you will likely be on lifelong synthroid anyway.

A TSH above 10 needs medication - sometimes gently in order to not induce/aggravate panic attacks.  My experience has been that the panic attacks are there independent of the thyroid - but thyroid levels that are abnormal can aggravate panic attacks as well as other psychological states.

Hope that answers the question.

[Still_Hoping]

Just a note on the panic attacks. They seemed to be isolated over a couple months. The fact that my TSH was at 5.47 (or higher by then) when they occured, my G.P said being hypo may have actually helped them to not be as bad as they could have.  That is why he did not treat the TSH then. He wanted to wait; I agreed.  That is when six months passed and the panic attacks basically are gone for the most part. That throat pressure persists unfortunately (and again I need to get an u/s done).

My reason for asking about Hashis despite neg ABs is because I wondered how a panic attack (and mine was incredibly acute at one point) could have happened with my being 5.47 TSH at the time.  I'm talking tachy/palps/c.p/s.o.b  and everything.  But after reading this site, I realized Hahi's can cause some "swings" and possibly I had a "swing" from Hashi's at that time?  I am basically trying to determine if my 'panic attacks' were real panic attacks or were they in fact from my hormones being off - as my thyroid hit my system with more hormone trying to keep up with itself (ie lower that TSH), which would be Hashis?   I'm hoping I don't have Hashis is the thing! I can deal with a minor panic attack caused by myself - but drug induced or thyroid /hormone induced panic attack is another story. It is one of my fears of being on PO meds truth be told.

[Still_Hoping]

To clarify - I personally have not yet had an U/S but hope to soon. The pressure in my throat (as noted by Dr Mark) may in fact be caused by something other than the thyroid most commonly, sinus issues and I do have those as well; additionally I have had some indigestion and as Dr noted this is oftentimes unrealized yet causes some throat irritation.  IF my thyroid is enlarged (my suspicion, unfortunately) I asked if by mouth med (PO med) could in fact cause my swollen/enlarged thyroid to go back down to size and thereby eliminate the pressure in my throat - and I believe Dr answered yes, by saying that treatment in my case with Synthroid should alleviate symptoms (sx) - which I believe includes not only the typical hypo symtoms which I have just about all of..but also to include the throat pressure if in fact the gland is swollen.  If I am wrong Dr Mark please correct me :) This is what I read from Drs response. Hope that helps.  As for why you have throat pressure and your gland is not to blame as evidenced by your U/S, I'd say again he may have answered your question via saying the other possible causes of throat pressure (and I am sure there are many possible causes, Dr named the 2 other most common ones for you though)..what I would say to you is, if your gland is not swollen, you may want to see an ENT (ear nose throat) doc to check into other possible causes, I believe this is what I will do if my gland is not swollen. Again hope that helps.  

I was just looking for hope that with treatment of PO meds (synthroid in my case) that a swollen gland could actually go back down to size! :)  

The one question that did NOT get answered however -  was my question: For those that have a swollen gland or nodules (etc) that do NOT receed with PO meds, why do they not just remove the entire gland rather than have people live with this horrible lump in their throat (given the pressure is from the gland)? Is it too risky? I'm just trying to understand why it is not more commonly removed in these cases as it seems that many many on this site have this very issue that remains something of a problem despite their medications - if I am understanding correctly their posts.

[christine01]

I have the exact same problem. In the morning the throat tightening is not too bad, but by pm i cant even swallow water. I was diagnosed with acid reflux disease and put on 2 prilosec a day; one in morning, one at night. I have stopped all caffeine intake, dairy, chocolate. I still am fighting this, somedays I think my throat is just going to close up. My thyroid was big, but they are saying this is not the problem and the synthroid has controlled all the other symptoms, except this one. What can we do to feel better? I have followed the diet, I take my acid meds, and still feel the throat tightening.

[gassy]

Unless I'm not reading the post right the throat question that was asked by still_hoping, christine01 and myself wasn't answered. Why is out throats tightening up? My u/s showed small and no nodules.

[Mark Lupo, M.D.]

Most common lump sensation causes would be post-nasal drip from sinus or reflux/heartburn (often otherwise silent).  Thyroid can cause this when enlarged.

The TSH of 12.47 definitely merits start of synthroid given your history described.  Hopefully the panic sensations will improve - every once in a while people will get over-stimulated with synthroid then it needs to be restarted at a low dose and slow titration.

Ultrasound (u/s) is the best imaging for thyroid.  The TSH elevation stimulates growth of thyroid and normalizing it with synthroid should improve the symptoms if they are due to enlarged thyroid (which will be documented with u/s).

You still may have hashimotos even with neg antibodies mentioned - the elevated TSH and history show hypothyroidism - documenting hashimotos is not necessary in this setting, just treating the TSH elevation (to a goal of around 1)

The panic attacks may need separate treatment if they persist.

Good luck

[gassy]

I have the same symptons as you and anxiously await Dr. Mark's answer. I have had a lump in my throat since June 30th/05 it appeared and is still there today Aug 26/05. Ultrasound came back normal(small) no nodules, 2 EKG's normal, blood work came back normal for the exception of TSH, last one was 0.07 and my dosage was lowered to 100 mcg (I was on 175 mcg I was being over medicated). I have been told I had acid reflux? aniexty? given pantaloc and ativan however still have this lump thing going on and at times pressure at the top of my chest. The lump sensation is not bad in the AM however by PM and evening my throat gets so tight and lump feels larger that I have no choice but to take the ativan which helps alittle.At times it feels like my tongue is swelling! Since I've had all these tests done and everything is normal these Dr's are thinking I'm nuts however I feel the lump not them!! Glad to hear I'm not the only one with a lump problem I actually thought somedays I was going nuts. Let's hope that Dr.Mark has some explanation for this. Take care. thanks in advance Dr.Mark!

[Still_Hoping]

Also forgot to add (sorry!) that orthostatic hypotension only occured during that panic attack episode. Since then, BP actually rises from sit - stand. Immediate rise of roughly 15 though still within normal limits.

[Still_Hoping]

Forgot to add to data: BP baseline had risen when TSH was 5.74 as noted above, but now, with TSH 12.27 BP average is back to norm baseline, taken on the arm at sitting/rest 110-114/68-70, resting pulse varies from 58 to 74 while sitting. And, desite this TSH level, I had begun exercise 3x/wk and eating with 3 snacks every day and have lost 10 pounds in the last month, plus 11 inches of fat. However I'm still 46 pounds over ideal weight. Am still please I was able to loose weight despite TSH level being so elevated.

[Still_Hoping]

Please forgive the typos!

[Still_Hoping]

Let me just say that the Endocrinologist that I saw here in town blew me off desite my levels and throat pressure b/c he knew I was a nursing student. Anyway, I am still wondering why if there is throat pressure they don't just remove this gland;
But regarding myself, as I said I've been c/o Sx for 7 years now, which have increased over time. Realizing the range of 'norm' is wide - My history based on labs in my file: 38 y.o Female
First complaints in 1999 - tested in the 2.1 ish range with wt gain - which continued.
10/03 TSH 2.46, Free T4 1.0 - 60 pounds over weight
7/04  TSH 2.24, HDL 53, LDL 114, Trig 51 - 60 pounds over weight - avg BP 110/65

12/04 TSH 5.74, T3 by ICMA 113, Thyroid auto AB <2.0, Thyroid Perioxidase AB <1.5, FTI 7.3, T3 uptake 29.9, Total T4 7.3, HDL 66, Trig 69, chol total 177, LDL 97 - still overweight. Notable rise in baseline BP to pre-hypertensive avg 138/89. (These tests looked over by the Endo that blew me off). The Endo commented on palp. thyroid was 'spongy' but it could be his 'imagination'. Ran tests to r/o secondary causes, all back normal. Refused to order tx and U/S despite throat pressure, cough and labs.

2/05 - acute and severe panic attacks with chest pain., palps, Tachy 120+ on occasion, when at TSH 5.74 no tx for TSH as noted above. Orthostatic hypotension noted with tilt due to loss of appetite and loss of sleep etc. G.P (not Endo) orders Xanax for interim.  Anxiety reduced, panic attacks subside almost to nothing. chest pain continues alternately, not severe.  G.P. noted "classic" Chostochondritis r/t stress. EKG normal; no echo ordered to date rule out MVP or otherwise.

8/22/05 Bloodwork done for thyroid follow up by ARNP (G.P too booked). TSH 12.27 Rx for Levo (synthroid) 50mcg to begin tomorrow. Pressure in throat still there, no notable exterior nodules palpable by myself. Dont have other labs yet but have been told all normal range. Antibodies not tested yet. Appt with ARNP on the 31st to discuss U/S MRI or CT. No family Hx of thyroid disease but father had type II (DM). Along with throat pressure I do find that I wake sometimes gasping for breath as if I had stopped breathing.

Questions:
Is it still possible I have Hashimotos despite tests already done?
What further tests do you recommend?
Would you recommend I see another Endo? (have been blown off by 2 now and am limited whom I can see due to insurance and lack of available docs)
What ways do they relieve this throat and dry cough pressure (note - hx of sinus irriation as well but throat pressure began with onset of TSH elevation)?
Is it possible throat pressure could be relieved with PO med?
Thank you.